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Published on: January 20, 2023
Abusive head trauma in young children: a population-based study
Anbesaw W Selassie1, Keith Borg, Carrie Busch
1Division of Epidemiology and Biostatistics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Insights
Abusive head trauma (AHT) incidence in children under 5 is underestimated without emergency department data. Intracranial bleeding is a key indicator for identifying AHT cases and improving surveillance.
Area of Science:
- Pediatrics
- Public Health
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a significant cause of injury in young children.
- Accurate incidence data is crucial for effective public health surveillance and prevention strategies.
Purpose of the Study:
- To estimate the population-based incidence of AHT in children aged 0–5 years.
- To identify risk characteristics associated with AHT to aid in recognizing high-risk children.
Main Methods:
- Retrospective cohort study of children aged 0–5 with head trauma (HT) encounters (2000-2010).
- Analysis included inpatient and emergency department (ED) data.
- Cox hazards regression and Kaplan-Meier methods were used to analyze clinical markers and survival time.
Main Results:
- 502 of 26,681 (1.8%) HT cases were attributed to AHT; 42.4% were identified in the ED.
- Incidence rates ranged from 28.9 per 100,000 in infants to 4.1 per 100,000 in 5-year-olds.
- Intracranial bleeding (HR 20.3) and retinal hemorrhage (HR 11.4) were significant indicators of AHT.
Conclusions:
- ED data is essential for comprehensive AHT incidence estimation.
- Intracranial bleeding is a critical clinical marker for AHT case ascertainment and surveillance.
Objective:
The objectives of this study were to provide population-based incidence estimate of abusive head trauma (AHT) in children aged 0 to 5 years from inpatient and emergency department (ED) and identify risk characteristics for recognizing high-risk children to improve public health surveillance.
Methods:
This was a retrospective cohort study based on children's first encounter in ED or hospital admission with a diagnosis of head trauma (HT), 2000-2010. The relationship between clinical markers and AHT was examined controlling for covariables in the model using Cox hazards regression. Kaplan-Meier incidence probability was plotted, and the number of weeks elapsing from date of birth to the first encounter with HT established the survival time (T).
Results:
Twenty-six thousand six hundred eighty-one children had HT, 502 (1.8%) resulted from abuse; 42.4% was captured from ED. Incidence varied from 28.9 (95% confidence interval [CI], 27.9-37.4) in infants to 4.1 (95% CI, 2.4-5.7) in 5-year-olds per 100,000 per year. Adjusted hazard ratio was 20.3 (95% CI, 10.9-38.0) for intracranial bleeding and 11.4 (95% CI, 8.57-15.21) for retinal hemorrhage.
Conclusions:
Incidence estimates of AHT are incomplete without including ED. Intracranial bleeding is a cardinal feature of AHT to be considered in case ascertainment to improve public health surveillance.
